Biomedical Engineering Reference
In-Depth Information
Sevak 2002; Hoenig et al. 2003; Agree et al. 2005). The physical component includes
perceived physical difficulty (Blake and Lincoln 2000; Gallego et al. 2001; Visser-Meily
et al. 2004, 2005), frequency of help, and number of hours of help (op Reimer et al. 1998;
Chen et al. 1999; Allen et al. 2001; Hoenig et al. 2003; Verbrugge and Sevak 2002; Taylor
and Hoenig 2004; Agree et al. 2005). The psychological component of the altered helper-
related activities includes participative necessity, satisfaction in providing help (Stuckey
et al. 1996; Chappell and Reid 2002), and emotional difficulty (Blake and Lincoln 2000;
Gallego et al. 2001; Visser-Meily et al. 2004).
This framework resonates with the assistive technology assessment (ATA) process model
in that it identifies the caregiver as a critical component of the environmental milieu, but
also emphasizes how an assistance solution that carefully considers the user's environ-
mental context can also influence that context, especially in terms of its impact on user's
informal caregivers.
5.3.2 Conceptual Framework 2
Demers et al. (2009) developed conceptual framework 2 to better understand the impact of
AT on the AT user's caregiver. According to this framework (see Figure 5.2), model caregiv-
ers' primary and secondary stressors have a direct influence on caregivers' outcomes, which
include quality of life, physical and psychological health, and social participation. Primary
stressors are directly related to the caregiving provided (e.g., types of assistance, number
of tasks, time required, safety, and physical effort). Secondary stressors are related to the
long-term impact of primary stressors on the caregiver and include role overload, decreased
free time, and home modifications required to accommodate an assistance user. Several fac-
tors help mediate the relationship between stressors and caregiver outcomes. These include
personal resources, coping strategies, and self-efficacy. Other factors can moderate the rela-
tionship between stressors and caregiver outcomes by altering the way in which care is
provided. AT is one moderating factor that, depending on the device type and amount and
manner of use, can decrease the areas of assistance provided, decrease time required, reduce
caregiver physical effort, and improve safety. Background and contextual factors also mod-
erate caregiving outcomes. Improvements in social support, environmental accessibility, liv-
ing arrangement, and quality of relationship can decrease primary stressors by reducing
caregiving or perceived stressors that can facilitate positive caregiver outcomes.
In applying conceptual framework 2 to the first vignette, it is evident that carrying
Charlie is a primary stressor for Susan and Harold that involves intense physical effort
and associated safety issues. The need to carry Charlie results in secondary stressors
because this decreases the amount of time they have for other activities. In terms of out-
comes, despite their existing personal resources, coping strategies, and a supportive social
environment, the stress of caregiving has reduced Harold and Susan's social participation,
physical health, and quality of life. Because Charlie will continue to grow larger and less
physically able, these outcomes are unlikely to improve unless moderating or mediating
factors can be altered.
In the second vignette, Jean experiences multiple primary stressors given all of her care-
giving tasks. These likely contribute to secondary outcomes that include role overload and
decreased free time. Despite the moderating influences of background and contextual fac-
tors and Bob's use of a cane, Jean experiences decreased social participation and reduced
physical and psychological health. Until Bob recovers from his surgery, which will not be
for several months, it is probable that Jean's outcomes will continue to decline unless mod-
erating or mediating factors are changed in some way.
